1669879086 NPI number — JENNINGS OPERATING LLC

Table of content: (NPI 1669879086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669879086 NPI number — JENNINGS OPERATING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNINGS OPERATING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669879086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10204 GRANGER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARFIELD HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44125-3106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-581-2900
Provider Business Mailing Address Fax Number:
216-581-4505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10204 GRANGER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARFIELD HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44125-3106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-581-2900
Provider Business Practice Location Address Fax Number:
216-581-4505
Provider Enumeration Date:
12/01/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SALOPECK
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
QUICK
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
216-581-2900

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  6331 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 2739 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)